Acute Antithrombotic Management Quiz

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Questions and Answers

What is the main treatment option recommended for most patients with CVT?

Unfractionated heparin (UFH)

Subcutaneous LMWH (correct)

Oral anticoagulants

Antiplatelet therapy

What is the immediate goal of antithrombotic treatment for CVT?

To cause pulmonary embolism

To treat arterial thrombosis

To induce thrombus propagation

To recanalize the occluded sinus/vein (correct)

What is the preferred anticoagulation option unless the patient is clinically unstable or there are contraindications?

Oral anticoagulants

Unfractionated heparin (UFH)

Subcutaneous LMWH (correct)

Antiplatelet therapy

What is not a contraindication for anticoagulant treatment in CVT?

Ischemic stroke Signup and view all the answers

What is the recommended treatment for children during the acute phase of CVT?

Similar to that for adults Signup and view all the answers

What is involved in the management of patients with COVID-19 vaccine-associated thrombosis?

Anticoagulation, intravenous immune globulin, reserved platelet transfusions Signup and view all the answers

What is considered appropriate treatment for acute CVT based on available data on efficacy, rapid onset of effect, and reversibility?

Anticoagulation with UFH or LMWH Signup and view all the answers

What percentage of patients were treated with anticoagulation according to the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT)?

More than 80 percent Signup and view all the answers

What did the meta-analysis of two randomized controlled trials of anticoagulation in acute CVT find?

Anticoagulant treatment for CVT may be associated with a reduced risk of death or dependency Signup and view all the answers

What do limited data suggest about LMWH compared to UFH for the treatment of CVT?

LMWH is more effective and at least as safe Signup and view all the answers

Are anticoagulants safe to use in adult patients with CVT who have associated intracranial hemorrhage?

Relatively low risks of new intracranial hemorrhage Signup and view all the answers

Why was the Berlin trial of intravenous heparin versus placebo stopped prematurely?

Excess mortality in the placebo arm Signup and view all the answers

What was the outcome of the Dutch trial of subcutaneous nadroparin versus placebo?

Favorable outcome for LMWH followed by oral anticoagulation Signup and view all the answers

In an open-label trial, what was the outcome for adults with CVT treated with LMWH compared to UFH?

Significantly lower in-hospital mortality and a greater proportion of patients with complete recovery for the LMWH group Signup and view all the answers

In a single-center double-blind trial, what was the outcome of the treatment with LMWH or UFH for cases of CVT?

No significant difference between the treatment groups in neurological deficits, disability, and mortality Signup and view all the answers

Study Notes

Treatment and Management of Cerebral Venous Thrombosis (CVT)

Treatment for children during the acute phase of CVT is similar to that for adults, but the evidence is weaker due to the lack of large randomized trials in this age group.
Management for patients with COVID-19 vaccine-associated thrombosis involves anticoagulation, intravenous immune globulin, and reserved platelet transfusions for cases of clinical relevant bleeding or high bleeding risk procedures.
Anticoagulation with UFH or LMWH is considered appropriate treatment for acute CVT, based on available data on efficacy, rapid onset of effect, and reversibility.
The International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT) showed that more than 80 percent of patients were treated with anticoagulation.
Two randomized controlled trials of anticoagulation in acute CVT have been published, with methodological problems and modest sample sizes.
A meta-analysis of these two trials found that anticoagulant treatment for CVT may be associated with a reduced risk of death or dependency, though not statistically significant.
Limited data suggest that LMWH is more effective than UFH and at least as safe for the treatment of CVT, based on small-scale trials and case-control studies.
Anticoagulants appear to be safe to use in adult patients with CVT who have associated intracranial hemorrhage, with relatively low risks of new intracranial hemorrhage.
The Berlin trial of intravenous heparin versus placebo was stopped prematurely due to excess mortality in the placebo arm, with significantly better outcomes for the heparin group.
The Dutch trial of subcutaneous nadroparin versus placebo found a favorable outcome for LMWH followed by oral anticoagulation, though not statistically significant.
In an open-label trial, 66 adults with CVT were randomly assigned to treatment with LMWH or UFH, showing significantly lower in-hospital mortality and a greater proportion of patients with complete recovery for the LMWH group.
In a single-center double-blind trial, 52 cases of CVT were randomly assigned to treatment with LMWH or UFH, with no significant difference between the treatment groups in neurological deficits, disability, and mortality.

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Description

Test your knowledge of acute antithrombotic management with this quiz. Explore the immediate goals of treatment for cerebral venous thrombosis (CVT) and understand the strategies to recanalize occluded sinuses/veins, prevent thrombus propagation, and address the underlying prothrombotic state.